Payer Enrollment Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage the comprehensive health plan enrollment process, from the retrieval of applications to notifying clients, by collaborating with external vendor partners.

• Directly handle highly escalated enrollment requests when necessary.

• Supervise ongoing enrollments through regular follow-ups via phone, email, and online portal.

• Ensure detailed and timely documentation is maintained within Medallion systems.

• Maintain a thorough understanding of payer-specific enrollment criteria, prerequisites, necessary forms, completion standards, supporting documentation, and relevant regulations.

• Keep supporting documentation updated in provider profiles, including onboarding documents, application copies, welcome letters, and associated correspondence.

• Prepare updates for clients that communicate the status and progress of enrollments.

• Cultivate and sustain relationships with payer representatives and contracting departments.

• Assist in revalidation processes to ensure active provider participation in health plans.

• Monitor payer enrollment timelines and deadlines to ensure compliance.

• Investigate and resolve any enrollment delays, rejections, or discrepancies by coordinating with providers, payers, and vendor partners.

• Stay informed about payer policies, state and federal regulations, and industry best practices.

• Carry out additional duties and responsibilities as assigned.

⛳️ Requirements

• Familiarity with applications and processes related to payer enrollment, typically requiring at least 3+ years of direct enrollment experience.

• Proficiency in GSuite tools, including Google Sheets, Google Docs, and Gmail.

• Detail-oriented with the ability to ensure that complex enrollment packages are complete and accurate.

• Strong communication skills to effectively interact with a diverse range of internal and external stakeholders at all organizational levels.

• Ability to work collaboratively in a team-oriented environment and foster positive working relationships both within and outside the organization.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health benefits package, including medical, dental, and vision coverage.

• Opportunities for professional development and career advancement.

• Flexible work environment with remote work options.

• Generous paid time off and holiday schedule.